Adenomyosis Symptoms: Heavy Periods, Pain and What to Track

The most common adenomyosis symptoms are heavy periods, painful periods, pelvic pain, a bloated or heavy tummy and pain during sex. Some people have no symptoms at all, so a normal-feeling month does not rule it out.

Adenomyosis happens when tissue like the womb lining grows into the muscle wall of the womb. This page is about how the symptoms feel and what to do about them. To compare it with endometriosis, read adenomyosis vs endometriosis.

Quick list of adenomyosis symptoms

You can have one of these symptoms or several:

• Heavy periods. You may need to change a pad or tampon every 1 to 2 hours.
• Painful periods. The cramps can be bad enough to stop your usual activities.
• Pelvic pain in the lower tummy, also on days when you do not bleed.
• Bloating, heaviness or fullness in the tummy.
• Pain during sex.
• Longer or irregular bleeding.
• Trouble getting pregnant.

About 1 in 3 people with adenomyosis have no signs or symptoms.

Heavy and long periods

Heavy bleeding is one of the main signs. A period counts as heavy if you change your pad or tampon every 1 to 2 hours, pass clots bigger than about 2.5cm, or bleed for more than 7 days. Bleeding from adenomyosis can be heavy or long and come with clots. Our guide to blood clots during your period shows which clots are usual and which need a check. If you are unsure whether your flow is too heavy, see the signs you are losing too much blood during your period.

Heavy bleeding month after month can lower your iron. Adenomyosis bleeding increases the risk of anaemia, which can make you feel tired or cold. Tell your doctor if you feel tired all the time on top of heavy periods.

Painful periods and pelvic pain

Period pain from adenomyosis can be severe enough to stop your usual activities. Pain does not always stay inside your period. Some people have pelvic pain in the lower tummy at other times of the month too.

In one group of people who had surgery for suspected endometriosis, almost all of those with adenomyosis alone had painful periods. Their pain load was close to that of people with endometriosis. Long-lasting pelvic pain and pain during sex were common in this group as well. If your symptoms come in waves, our page on adenomyosis flare-ups explains how to manage a bad stretch.

An enlarged womb, bloating and heaviness

As the tissue grows into the muscle, the womb can thicken and grow to double or triple its usual size. During a pelvic exam, a doctor may find that the womb is larger, softer or painful to the touch.

A bigger womb can give you a feeling of bloating, heaviness or fullness in your tummy. Some people see a swollen lower belly. Our guide to the adenomyosis belly shows what it looks like and how it differs from belly fat. Gut and bowel symptoms were common in people with adenomyosis in the same surgery study.

Pain during sex

Adenomyosis can cause pain during sex. This symptom is easy to leave out of a visit because it can feel awkward to talk about. Say it anyway. It helps your doctor think of adenomyosis and endometriosis. Our page on endometriosis and painful sex gives tips that help with both conditions.

Who gets adenomyosis

Anyone who has periods can get adenomyosis. It is more often diagnosed in women over 30 and in people who have given birth. It is most common between the ages of 40 and 50, but doctors now diagnose it more often in people in their 30s with heavy or painful periods.

Adenomyosis is linked to the hormone oestrogen, and symptoms often go away after menopause. It is not cancer, and it very rarely turns into cancer.

Adenomyosis and endometriosis together

You can have both conditions at the same time. Signs of adenomyosis on ultrasound are more common in people having surgery for endometriosis than in people without it. Adenomyosis is also more common in people who have endometriosis. If you already have an endometriosis diagnosis and your periods get heavier, ask whether adenomyosis could be part of the picture.

How doctors check for adenomyosis

A doctor will ask about your symptoms and may do a pelvic exam. The main tests are a transvaginal ultrasound or an MRI scan, which can show a thicker womb wall. These scans also help rule out other conditions with similar symptoms.

Treatment options

Treatment depends on your symptoms and on whether you want to get pregnant. Options include:

• Painkillers. Anti-inflammatory painkillers (NSAIDs) such as ibuprofen can ease the pain.
• Medicine for bleeding. Tranexamic acid can reduce heavy bleeding. Our guide to tranexamic acid for heavy periods covers its side effects.
• Hormone treatment. A hormonal coil (IUS) thins the womb lining and makes periods lighter and less painful. The pill or the patch are other choices.
• Surgery. If other treatments do not help, a doctor may suggest removing the womb lining or a hysterectomy. A hysterectomy can cure adenomyosis, but after it you cannot get pregnant.

When to see a doctor

See a GP or gynaecologist if:

• your periods are extremely heavy or affect your life
• you have severe cramps or pelvic pain
• sex is painful
• you feel fullness or heaviness in your tummy
• you bleed between periods or after sex

Get urgent help

Call 999 or go to A&E if you have pelvic pain and any of these:

• the pain is severe, getting worse, or hurts when you move or touch the area
• you feel faint, dizzy or lightheaded, or you pass out
• you have heavy bleeding from your vagina
• you have pain in the tip of your shoulder or trouble breathing

Get help from NHS 111 if you have pelvic pain with a very high temperature, or you are pregnant or may be pregnant. Outside the UK, use your local emergency number or urgent care service.

What to track before your appointment

Adenomyosis can take a long time to diagnose because its symptoms look like other conditions. A clear record makes your visit faster. Log these things for 2 to 3 cycles:

• how many days you bleed
• how often you change your pad or tampon on your heaviest day
• the size of any clots
• where the pain is, how bad it is (0 to 10) and which cycle day it starts
• pain during or after sex
• bloating, tiredness and any bowel or bladder changes
• any family history of heavy periods or hysterectomy

A pain diary for your doctor shows a simple way to set this up. The Endolog tracker app logs bleeding, pain and other symptoms day by day and turns them into a report you can share at your appointment. For bleeding and symptoms across the month, print the free period and symptom tracker.

Related guides

• Adenomyosis vs Endometriosis: Differences and Having Both
• Adenomyosis Belly: What It Looks Like and What Can Change
• Adenomyosis Flare-Ups: Managing Cyclical Symptom Spikes
• Identifying Heavy and Painful Periods